Updated: August 26, 2020 8:43:51 pm
She was supposed to get a kidney transplant towards the end of March. Till that point everything had gone well. Doctors had cleared her an ideal case for an organ transplant, her father had turned out to be a suitable match and with the paperwork over, even a date was scheduled. But that was when the pandemic came into the picture.
It’s been nearly five months since organ transplantation surgeries have been put on hold because of Covid-19. Since February, the woman in her mid-thirties, who did not want to be named, has been undergoing dialysis, spending up to four hours in the hospital every alternate date, every time exposing herself to the highly contagious virus.
Husband Srinivas says the regular visits to the hospital have forced them to relocate from Shadnagar, about 90 km from Hyderabad, to Bolarum, about 25 km from the government hospital. “Initially we used to take her to hospital in an auto-rickshaw. The journey up and down would cost around Rs 2000. Now, I take her on my bike every alternate day,” he says.
“Life has become quite difficult. I work in the day and take her to the hospital in the evening on alternate days. It would be midnight by the time we return. Doctors are unable to say when they would resume transplantation surgeries. And my wife and father-in-law, who is the donor, are both high-risk categories now,” he rues.
Organ donation is a highly complex procedure and in Telangana, the Jeevandan foundation of the state government has been facilitating cadaver organ donation and transplantation. Between 2013 and July 2020, the foundation has reported 768 organ donations and harvested 2,923 live organs for cadaver transplantation. Of all the organs, 2010 were kidneys.
The data available with Jeevandan shows there have been only nine organ donations between April and August 2020, resulting in 14 organs. At present, there is a requirement of 1615 kidneys, 678 livers, 41 hearts, 23 lungs, and 8 pancreases, in the state, according to their registry. While donations have stagnated, hitting a zero in the months of May and July, the number of recipient registration has also come down.
Dr Swarna Latha, in-charge for the Jeevandan programme, admits that COVID-19 has dealt a heavy blow to organ donations and transplantation surgeries in the state. “Most of the hospitals, including private ones, have joined COVID-19 management. Most of the healthcare workers, too, are busy managing the pandemic leading to their unavailability. Also, ICUs and ventilators are also diverted to treating COVID-19 patients,” she tells indianexpress.com. While the demand for an organ transplantation surgery is perennially high, recipients are now desperate and this could lead to them being exploited, she said.
In July, the Hyderabad police busted an international kidney racket with the arrest of a 25-year-old DS Pavan Srinivas in Hyderabad. The MBA allegedly cheated a family after collecting Rs 34 lakh from them for arranging a kidney donor and transplant surgery in Sri Lanka or Turkey, the police said.
Joint Commissioner A R Srinivas had then told the media that Pavan had facilitated around nine kidney transplants, earning a commission of Rs 6 lakh for each transplant. He, according to police, started arranging for kidney donors after he himself reportedly donated a kidney and realised the huge potential for earning easy money.
Dr. K L Dhananjaya, a Consultant Nephrologist and Transplant Physician, lists two reasons for a significant drop in organ transplantation surgeries. In the initial days of lockdown, the declaration of patients fit for organ donation was very less. Secondly, he says, elective surgeries were stalled, and later the government has issued guidelines suggesting postponement of transplantation surgeries wherever it was not an emergency.
“Unlike in cases of heart or liver failures, kidney failure cases always have an option to undergo dialysis and extend their life by a few months without transplantation. That’s why live-related kidney transplants got postponed,” he said. A certain fear factor, too, has crept in among patients when they are told about the risks involved.
“Many studies have shown that patients post their organ transplantation, since they are immunocompromised and on immunosuppressive medication, are at high risk of contracting any infection including coronavirus. So the severity of complication is higher in those who have undergone transplantation.” According to him, patients back out when they are informed of this situation. Even in the case of someone who tested positive for coronavirus, he said, transplantations cannot be performed due to the high dose of immunosuppressive medication they take.
A city-based Consultant Urologist and Renal Transplant Surgeon, Dr. Shyam Varma, feels the fear is justifiable to some extent. Stating that 8-10 of his patients are awaiting kidney transplantation, he said the desperation is increasing among patients. “A kidney transplantation surgery can be postponed. But since the patient has to visit the hospital for dialysis every alternate day, he/she is at a greater risk of exposure to coronavirus.”
Dr Swarnalatha said hospitals should have a COVID-free pathway and an exclusive team for transplantation. “They cannot mingle with others because health care workers can be a source of spreading the infection to recipients. Also, close monitoring of patients is required post-transplant surgeries,” she lists out the challenges faced.
When states like Kerala and Tamil Nadu have been doing transplantation surgeries as usual after taking all precautions and were showing an equally good success rate as pre-COVID era, Dr Varma feels Telangana should start considering the same.
“Unless authorities give a green signal, it is difficult to start. Also, a lot of awareness has to be created.”
Dr Swanalatha, also a senior nephrologist at the Nizam’s Institute of Medical Sciences, hoped doctors would be able to start organ transplantation surgeries in another month or two. “NIMS hospital is dedicated to the treatment of healthcare workers and paramedical staff but we are performing emergency and semi-emergency elective surgeries. We have had some organ donations since March but no transplantation. Only four Kidney and two Lung transplantations have taken up since March, all in private hospitals,” she said.
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